门静脉节段切除治疗进展期胰腺癌

目的 研究侵犯门静脉（PV）的胰腺癌的切除方法及治疗效果。方法 对22例胰腺癌患者在施行胰十二指肠切除或胰体尾部切除时清扫区域淋巴结，并联合切除受侵犯的一段PV或肠系膜上静脉（SMV）。结果 行PV或SMV楔形切除修补者6例，节段切除者8例，其中5例行端端吻合，2例行自体大隐静脉移植，1例行肠系膜上静脉下腔静脉转流。平均手术时间7.，平均术中输血600ml，无围手术期死亡。22例患者全部得到随访，存活6个月1例，12个月3例，18个月6例，24个月8例，36个月4例。结信纸 侵犯PV和（或）SMV的胰腺癌切除加广泛淋巴清扫是安全可行的，且能延长患者的生存期。

Segmental resection of involved portal vein for the treatment of advanced pancreatic carcinoma

Objective To evaluate segmental resection of involved portal vein (PV) in the surgical treatment of advanced pancreatic carcinoma (PC). MethodsIn our 22 advanced PC patients involving PV and/or superior mesenteric vein (SMV) extended pancreaticoduodenectomy or distal pancreatectomy plus extensive regional lymph node clearance were performed and cancer involved PV and/or SMV segment were resected enbloc. Results Among 22 cases, 6 underwent wedge resection and repairment of PV or SMV. Eight underwent segmental resection of PV or SMV followed by end-to-end anastomosis in 5,autotransplantation of great saphenous vein in 2, mesocaval shunt in one. The mean operation time was 7 5?h, the average blood transfusion was 600?ml, and there was no mortality in all cases. All 22 patients were followed up with a postoperative survival of 6 mos in one, 12 mos in 3, 18 mos in 6 cases, 24 mos in 8 and 36 mos in 4 cases. ConclusionsIt is rationale to resect the advanced PC en bloc with the cancer involved segment of PV and/or SMV in terms of low morbidity and long postoperative survival.